Audit of Illinois' Medicaid Payments for Skilled Professional Medical Personnel for the Period October 1, 2003 Through September 30, 2004

EXECUTIVE SUMMARY:

The objective of the audit was to determine whether the Illinois Department of Healthcare and Family Services (State agency) properly claimed Medicaid funding at the 75 percent enhanced Federal funding rate for skilled professional medical personnel for the period October 1, 2003, through September 30, 2004.  The State agency improperly claimed enhanced reimbursement for skilled professional medical personnel costs and was overpaid $62,648 in Federal funds for wage and travel expenses for 56 contractors that were not State agency employees.  In addition, the State agency improperly classified and claimed $9,460,819 ($2,365,205 Federal share) in school based administrative costs as skilled professional medical personnel.  Although CMS disallowed enhanced reimbursement for these claims, the State agency did not reclassify and reduce its claim for skilled professional medical personnel.  We recommended that the State agency:  (1) refund $62,648 for the overpayments; (2) develop and implement procedures to ensure only qualifying individuals are claimed as skilled professional medical personnel; and (3) reclassify the $9,460,819 in school based administrative costs inappropriately claimed for enhanced reimbursement as skilled professional medical personnel and appropriately charge those costs as other Medicaid administrative costs.  Illinois officials agreed to the first two recommendations.  The State did not agree with our recommendation to reclassify the $9,460,819 in school based administrative costs.